Intubación con paciente despierto con fibroscopio retromolar de Bonfils bajo sedación con dexmedetomidina Reporte de 7 casos

SUMMARYAcording to the “Practice Guidelines for management of a difficult airway”, and several algorithnes, an awake intubation is considered the first method to secure a suspected difficult airway. During last years the awake intubation was performed by flexible fiberoptic laringoscopy or with a rigid stylet. Within the last decade, many new devices have been developed to assist anesthesiologist with both routine and difficult airway management, one of wich is the Bonfils Retromolar Intubacion Fiberscope. It is a semi-rigid optical stylet 40 cm long of 5,0 external diameter and a tip curvature of 40 degrees; the adult stylet can accommodate a 6,5 mm endotracheal tube and sliding it in the superior airway, it is possible to entubate the glottis under direct vision. We present seven case report with difficult airway, managed with dexmedotomidine using the Bonfils retromolar fiberscope without topical anesthetic

Investigating the Extent of Primer Dropout in SARS-CoV-2 Genome Sequences During the Early Circulation of Delta Variants

The SARS-CoV-2 Delta variant, corresponding to the Pangolin lineage B.1.617.2, was first detected in India in July 2020 and rapidly became dominant worldwide. The ARTIC v3 protocol for SARS-CoV-2 whole-genome sequencing, which relies on a large number of PCR primers, was among the first available early in the pandemic, but may be prone to coverage dropouts that result in incomplete genome sequences. A new set of primers (v4) was designed to circumvent this issue in June 2021. In this study, we investigated whether the sequencing community adopted the new sets of primers, especially in the context of the spread of the Delta lineage, in July 2021. Because information about protocols from individual laboratories is generally difficult to obtain, the aims of the study were to identify whether large under-sequenced regions were present in deposited Delta variant genome sequences (from April to August 2021), to investigate the extent of the coverage dropout among all the currently available Delta sequences in six countries, and to propose simple PCR primer modifications to sequence the missing region, especially for the first circulating Delta variants observed in 2021 in Switzerland. Candidate primers were tested on few clinical samples, highlighting the need to further pursue primer optimization and validation on a larger and diverse set of samples

Pautas éticas para la reanimación cardiopulmonar en el contexto de la pandemia de COVID-19 en Colombia

The pandemic caused by COVID19 is associated with an increase in the number of cases of cardiorespiratory arrest, which has resulted in ethical concerns regarding theenforceability of cardiopulmonary resuscitation, as well as the conditions to carry it out. The risk of aerosol transmission and the clinical uncertainties about the efficacy, the potential sequelae, and the circumstances that could justify limiting this procedure during the pandemic have multiplied the ethical doubts on how to proceed in these cases.Based on ethical and legal grounds, this paper offers a practical guide on how to proceed in the clinical setting in cases of cardiopulmonary arrest during the pandemic. The criteria of justice, benefit, no harm, respect for autonomy, precaution, integrity, and transparency are asserted in an organized and practical framework for decision-making regarding cardiopulmonary resuscitation.La pandemia de COVID-19 se ha asociado con un incremento en el número de casos de paro cardiorrespiratorio y con ello han aumentado las inquietudes éticas en torno a la exigencia de la reanimación cardiopulmonar, así como sobre las condiciones para realizarla. El riesgo de contagio por aerosoles y las incertidumbres clínicas sobre la eficacia, las potenciales secuelas y las circunstancias que podrían justificar la limitación del procedimiento durante la pandemia, han multiplicado las dudas éticas sobre cómo proceder en estos casos.Con base en fundamentos éticos y jurídicos, en el presente artículo se ofrece una guía práctica sobre cómo proceder en los casos de paro cardiopulmonar en el contexto de la pandemia. Los criterios de justicia, beneficio, no daño, respeto a la autonomía, precaución, integridad y transparencia, se presentan de forma organizada y práctica para la adopción de decisiones en materia de reanimación cardiopulmonar

Ethical guidelines for the allocation of scarce health resources in the framework of the COVID-19 pandemic in Colombia

La pandemia por COVID-19 ha traído una inmensa presión sobre recursos sanitarios limitados, que incluyen personal de salud, elementos de protección personal y, de manera especialmente preocupante, camas de cuidado intensivo, ventiladores y demás equipos requeridos para el cuidado crítico

Revisión sistemática de la literatura y evaluación metodológica de guías de manejo invasivo de dolor lumbar

Objective: This article presents a systematic review of the literature on evidence based clinical practice guidelines for the interventional management of chronic low back pain and appraisal of the methodological quality of the guidelines and their recommendations. Methods: A systematic literature review was conducted using electronic databases of The National Guidelines Clearinghouse, National Institute for Clinical Excellence, Cochrane Back Review Group, PubMed, Clinical Evidence and Google. Only clinical practice guidelines on chronic low back pain treatment that encompassed interventional management were included. Two individual appraisers used the AGREE-II instrument to assess the methodological quality of the guidelines and also compare the recommendations regarding the invasive management of chronic low back pain. Results: Five guidelines published since 2005 met the inclusion criteria but only one was specific to interventional treatments. According to the AGREE-II, domains 1 (scope and purpose) and 6 (editorial independence) obtained the highest scores, while domains two (Stakeholder involvement) and five (Applicability) ranked lowest. Recommendations regarding diagnosis and non-invasive treatments were similar throughout the guidelines, however the evidence for interventional management was variable and inconsistent. Conclusions: In general guidelines exhibited a satisfactory methodological development and the most recent publications presented a better quality. However there was a consistent lack of clarity regarding cost-effectiveness, external peer review and implementation that we consider limit the adherence and distribution of the guidelines. Additionally, recommendations should be examined in the context of each patient, as per most targeted non-specific low back pain, which alters the level of evidence for the interventions reviewed.Objetivo: Realizar una revisión sistemática de la literatura de las guías de práctica clínica basadas en la evidencia para el tratamiento invasivo del dolor lumbar crónico y evaluar la calidad metodológica de las guías y sus recomendaciones. Materiales y métodos: Se realizó una revisión sistemática de la literatura en las bases de datos electrónicas National Guidelines Clearinghouse, National Institute for Clinical Excellence, Cochrane Back Review Group, PubMed, Clinical Evidence y en Google. Se seleccionaron únicamente guías de práctica clínica para el manejo del dolor lumbar crónico que incluyeran tratamiento invasivo, y con la herramienta AGREE-II se realizó una evaluación de la calidad metodológica por los autores de forma independiente. Adicionalmente se compararon las recomendaciones expuestas en las guías para el tratamiento invasivo del dolor lumbar crónico. Resultados: Cinco guías publicadas desde el año 2005 cumplieron los criterios de inclusión y sólo una está dirigida específicamente al manejo intervencionista. De acuerdo al AGREE-II, los dominios 1 (alcance y objetivo) y 6 (independencia editorial) obtuvieron los mayores puntajes, mientras que los dominios 2 (participación de los implicados) y 5 (aplicabilidad) fueron los más bajos. Las recomendaciones diagnósticas y de tratamiento no invasivo fueron similares a través de las guías revisadas, sin embargo la evidencia para el manejo intervencionista fue variable e inconsistente. Conclusiones: En general, el desarrollo metodológico de las guías fue satisfactorio y las publicaciones más recientes presentaron una mejor calidad. Sin embargo, falta mayor claridad en los procesos de costo-efectividad, revisión externa e implementación para facilitar su uso y adherencia. Adicionalmente se deben revisar las recomendaciones en el contexto del paciente, pues la mayoría están dirigidas al dolor lumbar inespecífico, lo que altera el grado de evidencia de las intervenciones

Intubación con paciente despierto con fibroscopio retromolar de Bonfils bajo sedación con dexmedetomidina: Reporte de 7 casos

Acording to the 'Practice Guidelines for management of a difficult airway', and several algorithnes, an awake intubation is considered the first method to secure a suspected difficult airway. During last years the awake intubation was performed by flexible fiberoptic laringoscopy or with a rigid stylet. Within the last decade, many new devices have been developed to assist anesthesiologist with both routine and difficult airway management, one of wich is the Bonfils Retromolar Intubacion Fiberscope. It is a semi-rigid optical stylet 40 cm. long of 5,0 external diameter and a tip curvature of 40 degrees; the adult stylet can accommodate a 6,5 mm. endotracheal tube and sliding it in the superior airway, it is possible to entubate the glottis under direct vision. We present seven case report with difficult airway, managed with dexmedotomidine using the Bonfils retromolar fiberscope without topical anesthetic

NASCarD (Nanopore Adaptive Sampling with Carrier DNA): A Rapid, PCR-Free Method for SARS-CoV-2 Whole-Genome Sequencing in Clinical Samples.

Whole-genome sequencing (WGS) represents the main technology for SARS-CoV-2 lineage characterization in diagnostic laboratories worldwide. The rapid, near-full-length sequencing of the viral genome is commonly enabled by high-throughput sequencing of PCR amplicons derived from cDNA molecules. Here, we present a new approach called NASCarD (Nanopore Adaptive Sampling with Carrier DNA), which allows a low amount of nucleic acids to be sequenced while selectively enriching for sequences of interest, hence limiting the production of non-target sequences. Using COVID-19 positive samples available during the omicron wave, we demonstrate how the method may lead to >99% genome completeness of the SARS-CoV-2 genome sequences within 7 h of sequencing at a competitive cost. The new approach may have applications beyond SARS-CoV-2 sequencing for other DNA or RNA pathogens in clinical samples

NASCarD (Nanopore Adaptive Sampling with Carrier DNA): A rapid, PCR-free method for whole genome sequencing of pathogens in clinical samples

Whole-genome sequencing (WGS) represents the main technology for SARS-CoV-2 lineage characterization in diagnostic laboratories worldwide. The rapid, near-full-length sequencing of the viral genome is commonly enabled by high-throughput sequencing of PCR amplicons derived from cDNA molecules. Here, we present a new approach, called NASCarD (Nanopore adaptive sampling with carrier DNA), which allows low amount of nucleic acids to be sequenced while selectively enriching for sequences of interest, hence limiting the production of non-target sequences. Using clinical samples positive for SARS-CoV-2 during the Omicron wave, we demonstrate how the method leads to up to >100x coverage of the full genome sequences of the target organism as compared to standard shotgun metatranscriptomics approach. It provides complete and accurate genome sequence reconstruction within seven hours at a competitive cost. The new approach may have applications beyond SARS-CoV-2 sequencing for other DNA or RNA pathogens in clinical samples

Intubación con paciente despierto con fibroscopio retromolar de Bonfils bajo sedación con dexmedetomidina: Reporte de 7 casos

Acording to the 'Practice Guidelines for management of a difficult airway', and several algorithnes, an awake intubation is considered the first method to secure a suspected difficult airway. During last years the awake intubation was performed by flexible fiberoptic laringoscopy or with a rigid stylet. Within the last decade, many new devices have been developed to assist anesthesiologist with both routine and difficult airway management, one of wich is the Bonfils Retromolar Intubacion Fiberscope. It is a semi-rigid optical stylet 40 cm. long of 5,0 external diameter and a tip curvature of 40 degrees; the adult stylet can accommodate a 6,5 mm. endotracheal tube and sliding it in the superior airway, it is possible to entubate the glottis under direct vision. We present seven case report with difficult airway, managed with dexmedotomidine using the Bonfils retromolar fiberscope without topical anesthetic

Intubation with awake patient with Bonfils retromolar fibroscope under dexmedetomidine sedation Report of 7 cases

Diversas guías de manejo y algoritmos para el manejo y control de la vía aérea difícil recomiendan la intubación con el paciente despierto, como un método seguro. En los últimos años la intubación en paciente despierto se ha realizado con fibroscopio flexible o mediante laringoscopia clásica y directa . Últimamente se han desarrollado múltiples dispositivos; entre dichos estiletes se destaca el fibroscopio retromolar de Bonfils; este es un instrumento óptico semi-rígido en una curva anterior de 40 grados. Al acomodarlo dentro de un tubo endotraqueal y pasarlo por la vía aérea superior, es posible dirigirlo bajo visión directa a la glotis. Se presentan en esta serie 7, casos de intubación en pacientes con vía aérea complicada, bajo sedación con dexmedetomidina con fibroscopia retromolar de Bonfils, sin aplicación de anestesia tópica.Acording to the “Practice Guidelines for management of a difficult airway”, and several algorithnes, an awake intubation is considered the first method to secure a suspected difficult airway. During last years the awake intubation was performed by flexible fiberoptic laringoscopy or with a rigid stylet. Within the last decade, many new devices have been developed to assist anesthesiologist with both routine and difficult airway management, one of wich is the Bonfils Retromolar Intubacion Fiberscope. It is a semi-rigid optical stylet 40 cm long of 5,0 external diameter and a tip curvature of 40 degrees; the adult stylet can accommodate a 6,5 mm endotracheal tube and sliding it in the superior airway, it is possible to entubate the glottis under direct vision. We present seven case report with difficult airway, managed with dexmedotomidine using the Bonfils retromolar fiberscope without topical anesthetic